Analysis

Standardised nursing uniforms: what do you want to wear to work?

An NHS consultation could see an end to the plethora of colours and styles used across England

An NHS consultation could see an end to the plethora of colours and styles used across hospital and community settings in England

  • The current system can be confusing for patients, with many different colours and styles worn by nurses at different trusts across the country
  • Wales, Scotland and Northern Ireland introduced national uniforms for nurses years ago, and NHS Supply Chain proposes a similar change for England
  • The uniform options that may be appropriate for staff in different settings, and how the consultation will work

Deciphering whos who in healthcare is a perennial problem, with patients and staff often confused by the multitude of uniform colours and styles.

...

An NHS consultation could see an end to the plethora of colours and styles used across hospital and community settings in England

  • The current system can be confusing for patients, with many different colours and styles worn by nurses at different trusts across the country
  • Wales, Scotland and Northern Ireland introduced national uniforms for nurses years ago, and NHS Supply Chain proposes a similar change for England
  • The uniform options that may be appropriate for staff in different settings, and how the consultation will work
Illustration showing nursing staff wearing different uniform colours and styles
Picture: Annette Taylor-Anderson

Deciphering who’s who in healthcare is a perennial problem, with patients – and staff – often confused by the multitude of uniform colours and styles.

But that could all be about to change. Nurses and other front-line staff are being asked to have their say in a consultation on whether a national, standardised uniform should be introduced in England for members of the multidisciplinary team in acute and community settings.

Uniform as part of nurses’ professional identity

NHS Supply Chain, which is responsible for purchasing items such as uniforms, is overseeing the consultation. It was initially launched in the summer of 2019 but was paused in 2020 due to COVID-19. It relaunched in April this year, and has received 45,000 responses so far, with the majority of respondents in favour of a national uniform, according to NHS Supply Chain.

If a national uniform is adopted, this would see England following in the footsteps of Scotland, Wales, and Northern Ireland, where standardised uniforms have been in place for several years.

Chief nursing officer for England Ruth May says patients and the public need to be able to identify which professional is providing their care, but adds that the uniforms debate is also about projecting a professional image.

30,000

separate uniform item styles exist in England

Source: NHS Supply Chain consultation proposal

‘Having a strong professional identity that reflects our diverse workforce is essential and I want to strengthen that identity,’ Ms May wrote in the consultation document.

‘I hear from colleagues that you want to celebrate and demonstrate that we are proud to display who we are and what we do, while helping patients and other professions to easily identify our roles.’

Here, Nursing Standard looks at what the consultation is asking, the logistics of moving to a national uniform, and what nurses think of the idea.

Why is a national uniform being considered now?

The current system is complex, with more than 30,000 separate uniform item options in use in the NHS in England, varying subtly by style, material and branding, compared with 154 in NHS Wales and 64 in NHS Scotland.

Existing national uniform contracts for England, which allow individual trusts and organisations to choose their own uniform designs and colours, will expire in April 2023. So if England wants to follow in the footsteps of the other UK nations and introduce a standardised uniform, now is the time to act.

NHS Supply Chain’s director of hotel services Kevin Chidlow believes it critical that as many people as possible respond to the consultation to get a clear view of what the workforce wants.

‘Trusts in essence are designing their own uniforms and deciding what style and colour scheme they’re going to buy,’ he says. ‘That is how it has been for a long time and gives rise to the plethora of styles and colours we currently have. Our aim in starting this process is to ask the question, “Can we do something different?”’

The lack of consistency means uniform colours and styles mean different things at different workplaces
The lack of consistency means uniform colours and styles mean different things at different workplaces Picture: Paul Stuart

What do nurses in England think of the idea of a national uniform ?

The issue has long been the source of debate for nurses in the workplace, at RCN congress and in Nursing Standard.

Of the 2,054 readers who responded to a 2019 Nursing Standard survey on the topic, 82% said they were in favour of a UK-wide standardised uniform, while 18% were against.

One respondent said: ‘I am a matron in one trust, the cleaners in a neighbouring trust wear the same uniform as me.’

Another commented: ‘We have standardised police, fire service and paramedic uniforms, so why not for other allied health professionals as well?’

In 2019 and 2020, NHS Supply Chain consulted a range of national organisations, professional bodies such as the RCN, and representatives from 23 different NHS trusts on uniform preferences. Findings from a follow-up series of workshops attended by 160 participants, including 65 nurses, revealed:

  • A preference for a two-piece uniform, consisting of a ‘smart scrub tunic’ (a more fitted version of a standard scrub top, with added pockets) and trousers, possibly navy blue.
  • Blue was the preferred colour for nurses’ uniforms, ranging from pale to darker tones to denote seniority.
  • Preferred colours for clinical nurse specialist tunics were dark red, purple or dark pink, with purple or red tops for matrons.
  • Favoured options for advanced practitioners were mid grey, dark pink or dark red, with heads of nursing and midwifery in black, mid grey or red.

Of the 65 nurses who attended the workshops, 82% favoured a smart scrub tunic and 75% were in favour of navy trousers, while 65% said a dress shouldn’t be an option should a national uniform be adopted.

What is the consultation proposing?

£10.8 million

could be saved over two years by switching to a national standard uniform in England

Source: NHS Supply Chain consultation proposal

The National Healthcare Uniform Project is a proposal put forward by NHS Supply Chain to introduce a nationally standardised uniform across the NHS in England.

The consultation questions cover two areas: whether staff agree with a national uniform approach; and the garment styles required for a well designed uniform. Depending on respondents’ answers to a number of questions, the consultation is proposing three possible options for a national uniform policy:

  1. Continue with the current system, where individual trusts decide uniform designs.
  2. Allow trusts to opt into a standard uniform design. While not all trusts are expected to sign up it would still generate estimated savings of up to £3 million over four to five years.
  3. All NHS trusts in England adopt a national healthcare uniform. A standard design would be rolled out over a two-year period.
Take part in the consultation

What are the potential benefits of a national uniform?

A standardised uniform is cheaper to produce. The NHS in England spends £23 million a year on uniforms. Initial estimates suggest a national approach could lead to about a 30% cost reduction, with potential savings of more than £10.8 million over two years.

Research suggests patients are strongly in favour of standardisation, to make it easier to recognise different members of healthcare teams.

In a survey of 500 patients and visitors across seven trusts, commissioned by NHS Supply Chain, 88% supported a standardised uniform.

National nurses uniforms were introduced in Wales in 2010
National nurses uniforms were introduced in Wales in 2010 Picture: Jay Williams

Patient safety is also a consideration. The 2013 Francis Inquiry into care failings at Mid Staffordshire NHS Foundation Trust emphasised the need to be able to identify staff with specific roles.

Other benefits suggested in the consultation document include greater recognition and respect for staff from the public and an enhanced professional appearance.

What are the potential drawbacks?

A standardised national uniform would mean trusts – and staff – would lose control over this aspect of how they are presented. There would be less flexibility and choice in the style of garments most trusts and/or staff could opt for.

Not all nurses wear uniforms – many working in mental health, learning disability and community services do not, for example. There are concerns that standardisation could lead to nurses being made to wear uniforms in settings where this is not practical or appropriate, with the risk of alienating service users.

There are also concerns that all senior nurses would be required to wear uniforms, whereas senior doctors do not have to.

This concern was echoed in the 2019 Nursing Standard survey, where one respondent said: ‘A national uniform would push advanced nurse practitioners and senior nurses into uniform and perpetuate the treatment of nurses as inferior to medically trained staff, even where they are doing the same job.’

Illustration showing a range of differnt uniform colours and styles for a range of different healthcare roles
Picture: iStock

Ensuring the uniform matches the setting and the role

Nurse adviser Doreen Crawford, who has been a children’s nurse for almost 40 years, says uniforms can create a divide between nurses and young patients.

‘For children coming into hospital it is a very strange experience,’ says Ms Crawford. ‘A uniform is not an asset in establishing a good relationship with a child and the family, it’s a barrier.’

Ms Crawford says the current uniform situation for children’s nurses in England is ‘chaotic’. ‘There’s no standardisation, there’s no guidance,’ she says. ‘Every trust does its own thing.’

She says if a standardised uniform is introduced there should be consideration and flexibility regarding staff working with children, to ensure uniforms are child-friendly and don’t make staff appear unapproachable.

‘Some trusts are very lenient and flexible and they allow things like sweatpants and tank tops or tabards,’ she says.

What about nurses working in the community?

The project encompasses nurses employed in any NHS trust in England, including those working in acute, mental health, community and other settings.

31 May 2021

Date the uniforms consultation closes

Mr Chidlow says: ‘Community nurses in one trust will wear uniforms and at another they won’t. We’re not trying to change that. However, if they do wear a uniform, we want to make sure they’ve got the best possible uniform. The same principle will apply in other clinical settings as well.’

The proposals do not include general practice nurses, although NHS Supply Chain says the scope could be expanded to include general practices if they wish to participate.

The uniform would not apply to nurses working in privately-run care or nursing homes.

When it comes to how colour groupings for nursing roles will work across hospital and community services, NHS Supply Chain says the aim is for groupings to be consistent across acute, mental health and community settings.

Uniform options for staff at Imperial College Healthcare NHS Trust
Some trusts have already adopted a system similar to that proposed by participants in NHS Supply Chain workshops, with varying shades of blue, as well as burgundy and grey

What is happening elsewhere in the UK?

Wales was the first UK nation to introduce a national nurses uniform, in 2010, consisting of a unisex tunic and matching trousers, in shades of blue. Staff nurses wear ‘hospital’ blue; hospital ward sisters, charge nurses and their deputies navy blue; and clinical nurse specialists royal blue.

The national uniform in Scotland, also introduced in 2010, consists of a tunic top or polo shirt and navy trousers. Registered nurses wear cornflower blue tunics, while senior charge nurses and community nurse team leaders wear navy blue. In 2017, a burgundy tunic was introduced for clinical nursing managers at band 8a and above – such as nurse directors, associate and deputy nurse directors – to make it easier for patients and visitors to identify who is in charge on a ward.

A national uniform was introduced in Northern Ireland in 2011, consisting of a tunic and navy trousers. Registered nurses wear ‘hospital’ blue, with deputy and clinical sisters and deputy and clinical charge nurses in royal blue, and sisters and charge nurses in red. Nurse specialists wear burgundy.

Managing change: ‘how it looks, feels and washes is important’

As former chief nursing for Scotland, Fiona McQueen knows both the benefits and some of the challenges of implementing a standardised uniform.

Following Scotland’s introduction of a common uniform in 2010, Ms McQueen helped oversee an update to the policy in 2017, with senior nurses allocated burgundy tunics to help patients and visitors identify them.

Looking back on that period, Ms McQueen says communicating uniform changes to senior staff was challenging, as some perceived that the established uniforms offered them a particular status.

The standardised nursing uniform options in Scotland
A standardised nursing uniform for Scotland gave recognition to every member of the nursing workforce, says Ms McQueen

Replacing a system staff recognise

‘People were not happy about losing their status,’ she says. ‘They had grown to know that system and link it to reward as they became more senior.’

But Ms McQueen says one of the benefits of the new system was the recognition it gave to every member of the nursing workforce. ‘It’s about valuing every single registrant, so you get away from “I’m only a staff nurse,” because staff nurses are the backbone of our services,’ she says.

While acknowledging that implementing such a change would be a larger task in England, where there are 223 NHS trusts, compared with Scotland’s 14 health boards, Ms McQueen supports such a change.

She says aspects such as how a uniform looks, feels and washes are crucial to its success, as well as listening to staff feedback.

But, she warns, it can be the small details that are the most contentious. ‘Many an hour was spent discussing should there be a zip fly opening for the men or not,’ she says.

The uniform consultation process: what happens next?

The consultation closes on 31 May, and the the results will be analysed and published over the summer.

If results show a consensus in favour of a national common uniform, then NHS Supply Chain will launch a procurement process to find suppliers.

Before any designs are finalised, prototype garments will be subject to laboratory testing and a ‘wearer trial’ programme. This would likely involve staff at up to ten different trusts in the autumn of 2021, and the uniform would be launched in late summer 2022.


Further information

NHS Supply Chain: National healthcare uniform proposal workforce consultation

Want to read more?

Subscribe for unlimited access

Enjoy 1 month's access for £1 and get:

  • Full access to nursing standard.com and the Nursing Standard app
  • Monthly digital edition
  • RCNi Portfolio and interactive CPD quizzes
  • RCNi Learning with 200+ evidence-based modules
  • 10 articles a month from any other RCNi journal

This article is not available as part of an institutional subscription. Why is this?

Jobs